Your search found 13 Results
Progress Toward Eliminating Mother to Child Transmission of HIV in Kenya: Review of Treatment Guideline Uptake and Pediatric Transmission at Four Government Hospitals Between 2010 and 2012.
AIDS and Behavior. 2016 Nov; 20(11):2602-2611.We analyzed prevention of mother-to-child transmission (PMTCT) data from a retrospective cohort of n = 1365 HIV+ mothers who enrolled their HIV-exposed infants in early infant diagnosis services in four Kenyan government hospitals from 2010 to 2012. Less than 15 and 20 % of mother-infant pairs were provided with regimens that met WHO Option A and B/B+ guidelines, respectively. Annually, the gestational age at treatment initiation decreased, while uptake of Option B/B+ increased (all p's < 0.001). Pediatric HIV infection was halved (8.6-4.3 %), yet varied significantly by hospital. In multivariable analyses, HIV-exposed infants who received no PMTCT (AOR 4.6 [2.49, 8.62], p < 0.001), mixed foods (AOR 5.0 [2.77, 9.02], p < 0.001), and care at one of the four hospitals (AOR 3.0 [1.51, 5.92], p = 0.002) were more likely to be HIV-infected. While the administration and uptake of WHO PMTCT guidelines is improving, an expanded focus on retention and medication adherence will further reduce pediatric HIV transmission.
Strong ministries for strong health systems. An overview of the study report: Supporting Ministerial Health Leadership: A Strategy for Health Systems Strengthening.
[Kampala], Uganda, African Centre for Global Health and Social Transformation [ACHEST], 2010 Jan.  p.This overview is adapted from the report Supporting Ministerial Health Leadership: A Strategy for Health Systems Strengthening by Dr. Francis Omaswa, executive director and founder of The African Center for Global Health and Social Transformation (ACHEST) and Dr. Jo Ivey Boufford, president of The New York Academy of Medicine (NYAM). The study and report were commissioned by the Rockefeller Foundation to explore the feasibility of establishing a support mechanism for ministers and ministries of health especially in the poorest countries, as part of the Foundation’s Transforming Health Systems initiative, The study was initially designed to assess the potential value of three proposed programs to strengthen the leadership capabilities of ministers of health: a global executive leadership program for new ministers; an ongoing, regional, in-person and virtual leadership support program for sitting ministers; and a virtual global resource center for ministers and high level ministerial officials providing real-time access to information. During the course of the study, it became clear that it was essential to expand the inquiry to better understand the challenges and needs of ministries as a whole, as they and their ministers provide the stewardship function for country health systems.The content of the report was derived from six major activities:a comprehensive literature review of the theory and practice of effective leadership development and organizational capacity building, and an environmental scan to identify any existing or planned leadership development programs for ministers of health or any that have occurred in the recent past globally; a survey of the turnover of ministers of health; targeted interviews with ministers, former ministers, and key stakeholders who interact with them, conducted between October 2008 and September 2009, to better understand the roles of ministers and ministries, the challenges they face, resources at their disposal, and their thoughts on what additional resources might enhance their personal effectiveness and that of their ministries; a consultative meeting of experts and stakeholders held in Bellagio, Italy part way through the project; participation of the project leaders (Omaswa and Boufford) in relevant global and regional meetings, as well as individual meetings about the project with critical leaders in international and donor organizations and potential champions of this effort; and a consultation with African regional health leaders to discuss the final report, held in Kampala, Uganda. (Excerpt).
INTER-AMERICAN PARLIAMENTARY GROUP ON POPULATION AND DEVELOPMENT BULLETIN. 1990 Dec; 7(12):1-5.A lack of support for and information about breast feeding has contributed to the decline in its practice worldwide. The article provides support for the benefits of breast feeding and discusses existing and potential legislation affecting breast feeding and urges policy makers to provide accurate information per Article 4 of the WHO/UNICEF Code. A list of the benefits includes: infant protection against disease, excellent and inexpensive source of nutrition, no contamination of milk supply, lower maternal risk, financial savings, and a complement to family planning. It is noted that artificial formulas and bottles are perceived by poor women as the desirable modern way, and formula companies promote their product in such a manner as to restrict the possibility of breast feeding. It is suggested that effective national health policies include: 1) paid maternity leave with government support, 2) job security after delivery with no loss of seniority, 3) establishment of breast feeding facilities in the workplace or community, 4) provision for nursery breaks without loss of pay, and 5) flexible employment arrangements such as part-time or shorter shifts. Most countries in the Western Hemisphere have a maternity leave policy with the exception of Belize, Saint Vincent, and the US. 18 countries have statutory provisions for nursing breaks at work, and 19 countries require nurseries to be available. Worker satisfaction and lower absenteeism are some benefits to companies supportive of breast feeding practices. The WHO/UNICEF education code recommends information on 1) the advantages of breast feeding, 2) maternal nutrition and preparation for breast feeding, 3) negative effects of partial bottle feeding, 4) the difficulty of resuming breast feeding after stopping, and 5) the correct preparation of breastmilk substitutes made commercially or at home.
Geneva, Switzerland, WHO, 1988. vi, 80 p.This publication focuses on the action needed to improve child health in growing urban centers in the 3rd world and outlines the staggering problems that stand in the way. It also gives an overview of community and governmental efforts to make improvements. Lastly, summary conclusions are drawn and recommendations given. The unprecedented population growth that has taken place in urban areas has created serious housing and health problems. Many people are living in illegally constructed housing with little or no provision for piped water, sanitation, collection and disposal of household waste, or health care. Chapter 1 discusses the health problems and poor living conditions that are common in urban centers. Studies of low-income settlements have identified 3 major types of pathology: infectious and gastrointestinal diseases, chronic degenerative diseases, and pathogenic conditions. It is estimated that up to 44% of all deaths in children under 4 years of age is a result of diarrhoeal disease. Respiratory infections and nutritional deficiencies are the other 2 major causes of morbidity and mortality in young children. Malnutrition poses one of the most serious threats to clinical health. It is estimated that 145 million children under 5 have insufficient diets. In urban low income communities up to 50% of children may show signs of malnutrition, 10% of this group in severe form. Malnutrition is a complex problem that involves not only a shortage of food, but also inadequate preparation and storage of food and lack of knowledge about nutrition. Many urban centers within developing countries share these relevant difficulties in regard to child health, but it is important not to make sweeping generalizations. As the book points out, urbanization has taken a multitude of forms, and the health problems of these urban centers need a variety of approaches. This publication sees a growing gap between child health needs and the responses of government. The last century has seen tremendous growth in urban population, as well as tremendous growth in the associate urban problems. Local and national response has been slight at best. Further, approaches have primarily been "sectoral " instead of the "multi-sectoral" approach that this book recommends. A "multi-sectoral" approach addresses a combination of urban problems all at once. It is further recommended that those in need of help to be targeted and prioritized. Also, a systematic coordination of individuals, households, neighborhood groups, local government, national government, and aid agencies is strongly urged. Local governments are deemed particularly crucial in the fight for child health.
AMERICAN JOURNAL OF PUBLIC HEALTH. 1990 Oct; 80(10):1188-92.Health trends since 1950 in both developed and developing countries are classified and discussed in terms of causative factors: socioeconomic development, cross-national influences and growth of national health systems. Despite the vast differences in scale of health statistics between developed and developing countries, economic hardships and high military expenditures, all nations have demonstrated significant declines in life expectancy and infant mortality rates. Social and economic factors that influenced changes included independence from colonial rule in Africa and Asia and emergence from feudalism in China, industrialization, rising gross domestic product per capita and urbanization. An example of economic development is doubling to tripling of commercial energy consumption per capita. Social advancement is evidenced by higher literacy rates, school enrollments and education of women. Cross-national influences that improved overall health include international trade, spread of technology, and the universal acceptance of the idea that health is a human right. National health systems in developing countries are receiving increasing shares of the GNP. Total health expenditure by government is highly correlated with life expectancy. The view of the World Bank and the International Monetary Fund that health care should be privatized is a step backward with anti-egalitarian consequences. The UN Economic Commission for Africa attacked the IMF and the World Bank for promoting private sector funding of health care stating that this leads to lower standards of living and poorer health among the disadvantaged. Suggested health strategies for the future should involve effective action in the public sector: adequate financial support of national health systems; political commitment to health as the basis of national security; citizen involvement in policy and planning; curtailing of smoking, alcohol, drugs and violence; elimination of environmental and toxic hazards; and maximum international collaboration.
[Unpublished] 1989. Presented at the 5th International Conference on AIDS, Montreal, Canada, June 4-10, 1989. 19 p.The charts and figures that comprise this document summarize the accomplishments of the World Health Organization's (WHO) Global Program on Acquired Immunodeficiency Syndrome (AIDS). As of May 1989, National AIDS Programs had been established in 188 countries/areas (46 in Africa, 42 in the Americas, 11 in Southeast Asia, 23 in the Eastern Mediterranean, 31 in Europe, and 35 in the Western Pacific). Program development involves a request, an initial technical visit, formulation of a short-term program, medium-term program formulation and resource mobilization, and program implementation and monitoring. National AIDS policies are formulated and publicized, a National Advisory Committee is created, a management structure is put in place, the relationships between the AIDS Program and other elements of the health care system are clearly defined, and financing is concretized. A review of the financial contributions to 29 National AIDS Programs in 1988-89 indicates the following funding sources: multibilateral (37%), bilateral (43%), WHO (18%), and national (2%). 126 of the National AIDS Programs currently in place are multisectoral and nongovernmental organizations are involved in 91 programs. Condom use in being promoted in 118 programs, while sentinel surveillance is in place in 46 programs. Preliminary program evaluations suggest a need for greater attention to management issues (e.g., structure, staffing, coordination with other sectors) and selected areas such as IEC monitoring, quality control in laboratories, patient care, sexually transmitted diseases, targeting, condom promotion, and perinatal transmission.
In: AIDS and associated cancers in Africa, edited by G. Giraldo, E. Beth-Giraldo, N. Clumeck, Md-R. Gharbi, S.K. Kyalwazi, G. de The. Basel, Switzerland, Karger, 1988. 292-302.The global strategy of AIDS prevention, managed by the WHO Special Programme on AIDS (SPA) was created in 1987, and is intended to be as intense as the smallpox eradication campaign. Its objectives are to prevent HIV transmission, to care for HIV-infected persons and reduce morbidity and mortality, and to unify national AIDS programs. AIDS can be prevented because it in only transmitted by 3 routes, sexual, blood and perinatal. AIDS-infected persons must be provided with medical, psychological and social support, without discrimination. The key elements of a national AIDS program are political openness, creation of a national AIDS committee, initial epidemiologic and resource assessment, and development of a medium-term AIDS plan. The plan should include epidemiological surveillance, laboratory capability, education programs for health workers, prevention of sexual transmission, prevention of blood transmission, prevention of intravenous drug abuse, strict single-use of medical and traditional skin-piercing instruments, and prevention of infection of women of childbearing age altogether. HIV-infected women should receive acceptable contraceptive methods. Evaluation of national programs is vital not only to maximize limited resources, but to discover how HIV prevention can best be achieved.
[Unpublished] 1988 May 21. 18 p. (NCIH 15th Annual International Health Conference; Papers)This address covers the 3 phases of National Primary Health Care (PHC) Implementation in Nigeria from 1975 to the present. The concept for the implementation of the 1st phase was to build and equip health centers, then train and post health workers to the facilities. No attempt was made to involve the community, use appropriate health technology, or set up management systems (such as referrals, supplies, monitoring, and evaluation of the delivery system). In short, at the end of the planned period, nowhere in the Federation were services, as described in the Alma Atta Declaration, being delivered. Between 1980 and 1985, because of the failure of the Basic Health Services Scheme, the Federal Ministry of Health abandoned any attempt to set up a PHC system and began the implementation of vertical systems of health care. Within the Ministry, groups attached themselves to particular agencies, leading to severe fragmentation of the Ministry. The Ministry as a whole had ceased to pursue the goals of PHC and adopted new objectives agreeable to each donor agency. Since 1985, the present Nigerian administration has aimed at establishing local government by local government, with the nation's PHC system incorporating the existing vertical programs. The considerable resources available through many AID agencies, international organizations, and governments need to be harnessed to achieve Nigeria's goals. Nigeria must therefore be clear as regards what these are and how to achieve them, bearing in mind that most of these agencies and organizations have their mandates and objectives limiting the activities in which they may engage.
Social Science and Medicine. 1987; 25(6):615-20.It is expected that community involvement in health policy be not only cost-effective but also the best way of providing comprehensive solutions to public health problems. Over 50 years of experience in India show that public enthusiasm does tend to wane after a short period of time, but efforts continue to be made. Governmental and other organizations and UN agencies have been active in promoting the concept of community involvement. The best that can be expected is that people will come forward voluntarily to participate in public health programs formulated by governments and other agencies. Generally, however, public cooperation has to be sought and participation motivated. There is little support for coercive measures. Community participation is often hampered by a wide range of factors including: difficult terrain; inegalitarian social structure; the tendency to depend on others to look after one's needs; and the absence of an understanding of healthful conditions and practices. Also, bureaucrats and medical professionals often consider community involvement an interference. Nevertheless individuals and organizations are everywhere engaged in experiments in such involvement, and certain Indian projects have provided valuable insights which may be of use in other developing countries.
Alternative approaches to meeting basic health needs in developing countries: a joint UNICEF/WHO study.
Geneva, World Health Organization, 1975. 116 p.Based on the failure of conventional health services and approaches to make any appreciable impact on the health problems of developing populations, this study examined successful or promising systems of delivery of primary health care to identify the key factors in their success and the effect of some of these factors in the development of primary health care within various political, economic, and administrative frameworks. In the selection of new approaches for detailed study, emphasis was placed on actual programs that are potentially applicable in different sociopolitical settings and on programs explicitly recognizing the influence of other social and economic sectors such as agriculture and education on health. Information was gathered from a wide range of sources; including members, meeting reports, and publications of international organizations and agencies, gathered country representatives, and field staff. The 1st section, world poverty and health, focuses on the underprivileged, the glaring contrasts in health, and the obstacles to be overcome--problems of broad choices and approaches, resources, general structure of health services, and technical weasknesses. The main purpose of the case studies described in the 2nd part was to single out, describe, and discuss their most interesting characteristics. The cases comprised 2 major categories: programs adopted nationally in China, Cuba, Tanzania, and, to a certain extent, Venezuela, and schemes covering limited areas in Bangladesh, India, Niger, and Yugoslavia. Successful national programs are characterized by a strong political will that has transformed a practicable methodology into a national endeavor. In all countries where this has happened, health has been given a high priority in the government's general development program. Enterprise and leadership are also found in the 2nd group of more limited schemes. Valuable lessons, both technical and operational, can be derived from this type of effort. In all cases, the leading role of a dedicated individual can be clearly identified. There is also evidence that community leaders and organizations have given considerable support to these projects. External aid has played a part and apparently been well used. Every effort should be made to determine the driving forces behind promising progams and help harness them to national plans.
Report of the evaluation of UNFPA assistance to Colombia's Maternal, Child Health and Population Dynamic's Programme, 1974-1978.
New York, United Nations Fund for Population Activities, July 1981. 181 p.This report for UNFPA (United Nations Fund for Population Activities) on Colombia's Maternal and Child Health and Population Dynamics (MCH/PD) program was prepared by an independent team of consultants which spent 3 weeks in Colombia in February 1980 reviewing documents, interviewing key personnel and observing program services. The report consists of 8 chapters. The 1st describes the terms of references of the evaluation mission. The 2nd chapter provides background information on Colombia and identifies some of the principal environmental factors that affect the program. Chapter 3 describes the organizational context within which the program operates. The chapter also includes a discussion of the UNFPA funding and monitoring mechanism and how that affects program planning and operations. Chapter 4 is a description of the program planning process; goals, strategies and objectives, and of the UNFPA and government inputs to the program between 1974-1978, the period under review. A large part of the report is devoted to describing and assessing each program activity. Chapter 5 consists of descriptions of management information; maternal care; infant, child and adolescent care; family planning; supervision; training; community education; and research and evalutation studies. Chapter 6 is an analysis of the program's impact on: maternal morbidity and mortality; infant morbidity and mortality; and fertility. Chapter 7 summarizes the Mission's conclusions and lists its recommendations. The final chapter deals with the Mission's position in relation to the 1980-1983 proposal. Appendices provide statistical data on medical activities, contraceptive distribution and use, content of training courses, target population, total expenditures, and norms for care, as well as organizational charts, individuals interviewed, and UNFPA assistance to other agencies in Colombia. (author's modified)
How many people? A Symposium. Foreign Policy Association, 1973. (Headline Series No. 218) p. 7-15. December 1973The progress of the family planning and population control movements are traced with particular regard to the significant role played by early volunteer organizations like the International Planned Parenthood Federation (IPPF) which was formed in 1952 by the National Family Planning Associations of India, the U.S., Britain, Hong Kong Germany, Holland, Sweden and Singapore. Global recognition of the population problem has been fostered in part by the universal trend toward urbanization, the sharp reduction in maternal and child deaths, the gradual improvement in the status of women, and other social changes which created a demand for better living conditions. The current trend toward assessing national development prospects in terms of social objectives represents a merger between demographic policy and family planning programs. This union between the public and private sector is largely due to the efforts of voluntary family planning groups who have sought to demonstrate that provision of birth control services and education would result in individual efforts to control fertility. Pioneers like the IPPF lobbied and forced action on the evidence that family size and population growth are related integrally to the social and economic progress which the UN and national governments were trying to create. In the mid-60s, the UN officially recognized the efforts of volunteer agencies and within 2 years, the World Health Organization, the International Labor Organization, UNESCO, UNICEF and the Food and Agriculture Organization acknowledged the contribution of family planning to their own efforts to improve living standards. By 1965, family planning had been introduced in 92 countries and governments committed to population control numbered 10. The IPPF has received increased funding from the U.S., Britain and Sweden to supplement their aid to emerging voluntary organizations which are still dependent on private funding. Governments rely on the private sector during their early experiments with national services as well as on the efforts of the voluntary movement to get services fully utilized. Public and private sector activities tent to become mutually supportive. No voluntary association has been able to develop a nationwide clinic service alone. Government involvement provides essential public health facilities. Family planning organizations, in continuing roles as catalyst and pressure group, can be vital to emerging national programs, and can assist governments with problems of training, administration, distribution and coordination which are essential to the efficient delivery of services.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):546-53.Control of measles in tropical Africa has been attempted since 1966 in 2 large programs; recent evaluation studies have pinpointed obstacles specific to this area. Measles epidemics occur cyclically with annual peaks in dry season, killing 3-5% of children, contributing to 10% of childhood mortality, or more in malnourished populations. The 1st large control effort was the 20-country program begun in 1966. This effort eradicated measles in The Gambia, but measles recurred to previous levels within months in other areas. The Expanded Programme on Immunization initiated by WHO in 1978 also included operational research, technical assistance, cooperation with other groups such as USAID, and development of permanent national programs. Cooperative research has shown that the optimum age of immunization is 9 months, and that health centers are more efficient at immunization, but mobile teams are more cost-effective as coverage approaches 100%. 53 evaluation surveys have been done in 17 African countries on measles immunization programs. Some of the obstacles found were: rural population, underdevelopment of infrastructure, and exposure of unprotected infants contributing to the spread of measles. Measles surveillance is so poor that less than 10% of expected cases are reported. People are apathetic or unaware of the importance of immunization against this universal childhood disease. Vaccine quality is a serious problem, both from the lack of an adequate cold chain, and lack of facilities for testing vaccine. The future impact of measles control from the viewpoint of population growth and health of children offers many fine points for discussion.